Co-Pays, Coupons & Discounts: When Free Isn’t

After virtually every seminar I conduct, a DC asks me a question privately about discounted services. Whether it’s free exams, low-cost x-rays, or waiving co-pays, the doc is usually concerned that he is violating some rule or law by marketing his practice in this manner and too embarrassed to ask the question publicly.

Often, the DC’s will confide that they don’t like giving away services but that some practice management “guru,” new patient “master” or marketing “expert” recommended this as a viable way of obtaining new patients.

I know I have been taught that “if you can’t say anything nice don’t say anything at all.” But if I actually was able to adhere to that, there is little chance of you ever reading one of my blogs, columns or books as I suspect that biting one’s tongue doesn’t translate well on paper or online.

So, while I am not about to debate the effectiveness that these promotional methods may have or wax on about their effect on the public image of chiropractic, I will say a few words about their legitimacy in the realm of billing and compliance. (Excuse the generalizations here as I cannot devote enough space to address each state’s individual laws separately)

Most providers are required to bill for all services rendered per our insurance contract. Therefore, the routine use of free exams as a method of getting new patients are likely a violation of that contract.

Most insurance contracts prohibit providers from waiving co-payments or co-insurance amounts. Some state laws also have specific provisions that waiving a co-payment is illegal.

Providing deeply discounted services may also be problematic, particularly for Medicare. For example, if your normal exam fee is $100 and you run a promotion that gives the exam away for $29, you be faced with penalties from Medicare for “inducement.” Per Medicare regulations, you are not allowed to give away anything over $10, else you may be accused of illegally enticing a patient to use your office or your services.

With the advent of Medicare RAC contractors coming our way, increased scrutiny from third-party payers and post-payment audits becoming all too common, this may be a good time to review your standard operating procedures within your clinic.

Frankly, just because you’ve been doing some promotion for a while, doesn’t guarantee its legitimacy or legality. Sorry if I am the first to tell you, but the days are gone when you could actually tell if you are doing something correctly by the fact that you are paid for it. Welcome to the new era: you can perform the service, bill it, get paid — and THEN – someone can ask for their money back or fine you for doing so!

If you think that I am inflating the seriousness of this problem, think again. I make a habit of reviewing my consulting client’s websites and also have viewed enough chiropractic websites to virtually guarantee my optometrist a lifetime residual income.

What surprises me is how many clinics advertise discounts or freebies that are in direct violation with Medicare and/or their state laws. By my very non-scientific estimation, I would say that half of the chiropractic websites out there are offenders. Four words if you are in this category: take it down now! You’d be better off with no web presence than one that gets you in hot water.

Again, I am not saying such promotions are not effective. However, violations of statutes can bring up to $10,000 per incident fines. Certainly, that reduces the overall profitability of obtaining that patient into your clinic and gives you more potential headaches.

There are many legitimate ways to boost your revenues. In my consulting business, I focus on proper billing, coding, documentation and collections. We also look at your practice to see if it is ripe for expansion in other areas that could prove profitable. However, one thing that I constantly advise my clients is to make sure that what they are doing is above board.

So, before you get involved in some marketing scheme that could land you in trouble, consider the potential consequences. Before you give in to a patient’s request to waive a co-pay, weigh the costs. And before you give just about anything away to a Medicare patient, consider the fact that the patient will likely be dead and gone before you ever finish paying fines you incurred on their behalf. A little morbid, I know, but sometimes reality is just not pretty.

I may be simplifying things a bit,t but in my opinion, I would much rather keep all of what I make (minus whatever inevitable taxes they will extract from me), than make more and risk getting it taken away.

You might be thinking, well how am I going to afford all my fancy clothes, my exotic vacations and shiny sports car? As I said before, there are many legitimate ways to increase your income, so don’t get your feathers ruffled just yet. Plus, my guess is that your oldest pair of jeans will look good in comparison to those orange suits they hand out in prison!